HomeMy WebLinkAbout100 Willner Cir 05-16631i
CITY OF SANFORD PERMIT APPLICATION
Permit # : u - 1 �Q Date:
Job Address: ook✓,/iu=,7 �,i7 3� 77/ �.U)� 'S ilNj% S//��
Description of Work: Rrwct•!_ 5/,pc .O..f wee r,z.rni: iv.`w5�.ceCislj7yw'�+[( i?rfA ri �� ,�-T
Historic District: Zoning: Value of Work: S !� eee. le,
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole ____
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water &'Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential or Commercial _
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type:., # of Stories: —A— # of Dwelling Units: Flood Zone: (FEMA form required for n0wr than X)
Parcel #: 1(, - l y- 30 oa-20— 000 0 (Attach Proof of Ownership & Legal Description)
Owners Name &Address: 1.4 WE /`%�r//2o� �SsC• C'_ L P C'/G /-9/11) Till .5 /✓[ �a/ HCi� K it ✓+=�t✓.i✓T iZ . f � r, I�
Phone:
Contractor Name & Address: PA TE 16:110 0 a 1 550 C . rNC f A LV AINc /L'C%► /7 rf P4
/01.,1-:2 /yC M ORL 5JY1% State License Number. 5 ? k
Phone & Fax: -'ICY- %y0 03r/ rX 7V0-•,Q , r / Contact Person: PF %t i7 r141A n/A u 0l= Phone: y0 _:q04 ' %�G�
Bonding
Address:
Mortgage
Address:
Architect/Engineer:
C' �. y
Address: /.��
Phone:
Fax:
Application is hereby made to obtain a pert Wkb the work and installat' 1 c fy,%at no work or installation has commence4l prior io the
...
issuance of a permit and that all work will . ,jtelforme 1 aw la�ng construction in this jurisdiction. 1 understand that a separate
permit must be secured for ELECTRICAL:WORK. PL 5i O LS, FU"i ,CES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: 1 certify that all Rfthp Wregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT iN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER Olt AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is nfrcatron t 1 will notify the owner of the property of the requirem of Fl �a Lien Law,
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Signature of Owne0/gent Date r lu of Contractor/A nt bate
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Pun-caner/Agent' Name t C tractor/Agent's Nfime
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Signature of Notary -State of Florida Date Signature of Notary -State of Florida bati
Owner/Agent is _ P" ersonally Known to Me or Contractor/Agent is _ Pers,
Produced 1D _ Produced ID
APPLICATION APPROVED BY: Bldg: `— I. l -&>Ig:
(Initial & Date)
Special Condi
Utilities:
(initial & Date) (Initial &
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